Bipolar disorder and adherence: implications of manic subjective experience on treatment disruption

Samuel Bulteau,1,2 Marie Grall-Bronnec,1,2 Pierre-Yves Bars,3 Edouard-Jules Laforgue,1 François Etcheverrigaray,4 Jean-Christophe Loirat,3 Caroline Victorri-Vigneau,2,4 Jean-Marie Vanelle,1 Anne Sauvaget1 1CHU de Nantes, Addictology and Liaison Psychiatry Department, Nantes, France; 2University of Nantes-University of Tours, INSERM, SPHERE U1246 – “methodS for Patients-centered outcomes & HEalth REsearch”, l’Institut de recherche en Santé 2, Nantes, France; 3Clinique du Parc, Nantes, France; 4CHU de Nantes, Department of Clinical Pharmacology, Nantes, France Objective: Therapeutic observance is one of the cornerstones of bipolar disease prognosis. Nostalgia of previous manic phase has been described as a cause of treatment retrieval in bipolar disorder. But to date no systematic study has examined manic episode remembering stories. Our aim was to describe manic experience from the patient’s point of view and its consequences on subjective relation to care and treatment adherence. Patients and methods: Twelve euthymic patients with bipolar I disorder were interviewed about their former manic episodes and data was analyzed, thanks to a grounded theory method. Results: Nostalgia was an anecdotal reason for treatment retrieval in bipolar I disease. Although the manic experience was described as pleasant in a certain way, its consequences hugely tarnish the memory of it afterward. Treatment interruption appears to be mostly involuntary and state-dependent, when a euphoric subject loses insight and does not see any more benefit in having treatment. Conclusion: Consciousness destructuring associated with mood elation should explain treatment disruption in bipolar I patients more than nostalgia. Taking a manic episode story into account may help patients, family, and practitioners to achieve better compliance by improving their comprehension and integration of this unusual experience. Keywords: nostalgia, mania, compliance, insight, psychoeducatio

Tratamento farmacológico da distimia: avaliação crítica da evidência científica Pharmacological treatment of dysthymia: a critical appraisal of the evidence

Distimia é um transtorno depressivo de natureza crônica, mas de menor gravidade que a depressão maior, cujos sintomas persistem por mais ou menos dois anos. Este artigo aborda aspectos relativos à eficácia do tratamento farmacológico na distimia, a partir de resultados de revisões sistemáticas recentemente concluídas. Em termos de eficácia, os resultados foram similares para as diferentes classes de drogas, tais como tricíclicos (ADT), inibidores seletivos da recaptação da serotonina (ISRS), inibidores da mono-amino-oxidase (IMAO) e outras drogas (sulpirida, amineptina, e ritanserina). Os pacientes tomando tricíclicos relataram um maior número de efeitos adversos, comparado com placebo. Em resumo, o tratamento farmacológico da distimia é eficaz, sem efeito diferencial entre os diversos antidepressivos. O uso de tricíclicos está associado à maior ocorrência de efeitos adversos e de desistências. Apesar de a distimia ser uma doença crônica, existe ainda informação limitada sobre a qualidade de vida dos pacientes e sobre o tratamento a médio e longo prazo.<br>Dysthymia is a depressive disorder of chronic nature but of less severity than major depression, in which depressive symptoms are more or less continuous for at least two years. This paper discusses the role of pharmacological treatment for dysthymia. Similar results are found in terms of efficacy for different groups of drugs, such as tricyclic (TCA), selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAOI) and other drugs (sulpiride, amineptine, and ritanserin). Patients treated on TCA are more likely to report adverse events, comparing with placebo. In conclusion, pharmacological treatment seems to be effective in the treatment of dysthymia with no differences between and within class of drugs. Although dysthymia is a chronic condition, there remains little information on quality of life and medium or long-term outcome